Cited by 1,326Pharmaceutical Practices and Patient OutcomesBalance, Gait, and Falls PreventionFrailty in Older Adults

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Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons

Woolcott, John C.·2009·Archives of Internal Medicine

DOI 10.1001/archinternmed.2009.357

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Abstract

BACKGROUND: There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis. METHODS: Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs) RESULTS: Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); beta-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for beta-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment. CONCLUSION: The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.

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Background
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Background
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Background
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Background
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Background
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Background
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Result
Incidence and risk factors for falls among community-dwelling elderly subjects on a 1-year follow-up: a prospective cohort study from Ernakulam, Kerala, India
Sasidharan, D. K., Vijayakumar, P., Raj, M., Soman, S., Antony, L., Sudhakar, A., & Kabali, C. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-033691 · Cited by 31
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“The deleterious effects of psychotropics in older adults are well known, and it is now established that they increase the risk of falling and poor cognition (Sink et al., 2005; Woolcott et al., 2009).”
Background
Prescripción de benzodiacepinas y caídas en mujeres y hombres ancianos
Martínez‐Cengotitabengoa, M., Díaz-Gutiérrez, M. J., Besga, A., Ampudia, C. B., López‐Mahía, P., Rondón, M. B., Stewart, D. E., Pérez, P., Gutiérrez, M., & González-Pinto, A. M. (2017) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2017.01.004 · Cited by 30
Variation of Follow-Up Rate After Psychiatric Hospitalization of Medicare Beneficiaries by Hospital Characteristics and Social Determinants of Health
Benjenk, I., & Chen, J. (2018) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.08.006 · Cited by 30
Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities
Jiang, Y., Xia, Q., Wang, J., Zhou, P., Jiang, S., Diwan, V. K., & Xu, B. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16234623 · Cited by 30
Alcohol use among older adults: A comparative study across four European countries
Rossow, I. M., & Træen, B. (2020) · Nordic Studies on Alcohol and Drugs · doi:10.1177/1455072520954335 · Cited by 30
Association of perioperative midazolam use and complications: a population-based analysis
Athanassoglou, V., Cozowicz, C., Zhong, H., Illescas, A., Poeran, J., Liu, J., Poultsides, L. A., & Memtsoudis, S. G. (2022) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2021-102989 · Cited by 30
Fall risk-increasing drugs and gait performance in community-dwelling older adults: A systematic review
Osman, A., Kamkar, N., Speechley, M. R., Ali, S., & Montero‐Odasso, M. (2022) · Ageing Research Reviews · doi:10.1016/j.arr.2022.101599 · Cited by 29
Antidepressant Prescriptions: An Acute Window for Falls in the Nursing Home
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“4- to 6-fold increased risk of falls (6,7).”
Background
Depressive symptoms are independently associated with recurrent falls in community-dwelling older adults
Grenier, S., Payette, M., Langlois, F., Vu, T. T. M., & Bherer, L. (2014) · International Psychogeriatrics · doi:10.1017/s104161021400074x · Cited by 30
Non-tricyclic and Non-selective Serotonin Reuptake Inhibitor Antidepressants and Recurrent Falls in Frail Older Women
Naples, J. G., Kotlarczyk, M. P., Perera, S., Greenspan, S. L., & Hanlon, J. T. (2016) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.08.008 · Cited by 30
Evaluation of risk factors that contribute to falls among the elderly
Alves, R. L. T., Silva, C. F. M. E., Pimentel, L. N., Costa, I. D. A., Souza, A. C. D. S., & Coelho, L. A. F. (2017) · Revista Brasileira de Geriatria e Gerontologia · doi:10.1590/1981-22562017020.160022 · Cited by 29
Risk factors associated with accidental falls among Italian nursing home residents: A longitudinal study (FRAILS)
Castaldo, A., Giordano, A., Incalzi, R. A., & Lusignani, M. (2019) · Geriatric Nursing · doi:10.1016/j.gerinurse.2019.06.003 · Cited by 29
Association of Tramadol Use With Risk of Hip Fracture
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Patient Falls and Injuries in U.S. Psychiatric Care: Incidence and Trends
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Queda entre idosos no Brasil e sua relação com o uso de medicamentos: revisão sistemática
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Identification and team-based interprofessional management of hospitalized vulnerable older adults
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The Psychiatric Cultural Formulation
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Fall and Fracture Risk in Nursing Home Residents With Moderate-to-Severe Behavioral Symptoms of Alzheimer’s Disease and Related Dementias Initiating Antidepressants or Antipsychotics
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“The composite outcome was assessed because both fracture and fall events are strongly associated with use of psychopharmacological medications (8,10), are important causes of morbidity (9), and their relationship is intertwined and recursive (30).”
BackgroundMethod
Antidepressant use and risk of hip fractures among community‐dwelling persons with and without Alzheimer's disease
Torvinen‐Kiiskinen, S., Tolppanen, A., Koponen, M., Tanskanen, A. J., Tiihonen, J., Hartikainen, S. A., & Taipale, H. T. (2017) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4667 · Cited by 29
“Antidepressant use has been associated with an increased risk of falls and fractures in several previous studies (Bakken et al., 2013; Darowski et al., 2009; Hartikainen et al., 2007; Liu et al., 1998; Marcum et al., 2016; Oderda et al., 2012; Van Den Brand et al., 2009; Woolcott et al., 2009).”
BackgroundResult
Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk
Emeny, R. T., Chang, C., Skinner, J., O’Malley, A. J., Smith, J., Chakraborti, G., Rosen, C. J., & Morden, N. E. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.15348 · Cited by 30
Managing medical and psychiatric multimorbidity in older patients
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“206,207 A study of adverse drug reactions among psychiatric inpatients with multimorbidity found that extrapy-ramidal events were the most common adverse drug effect, followed by alterations in heart rate or blood pressure, and thirdly electrolyte disturbances including SIADH, hyponatremia or…”
Background
Treating hypertension in the very elderly—benefits, risks, and future directions, a focus on the hypertension in the very elderly trial
Peters, R. K., Beckett, N. S., McCormack, T., Fagard, R. H., FLETCHER, A. E., & Bulpitt, C. J. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht464 · Cited by 29
“However, when this was adjusted for co-variates the association was no longer significant.(30) Orthostatic hypotension (OH) too has been associated with BP lowering medication and OH itself is associated with an increased risk of falling and with adverse outcomes in terms of mortality and worsening cognition.”
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Falls: The Adverse Drug Reaction of the Elderly and the Impact of Pharmacogenetics
Just, K. S., Schneider, K. L., Schurig, M., Stingl, J., & Brockmöller, J. (2017) · Pharmacogenomics · doi:10.2217/pgs-2017-0018 · Cited by 29
In-hospital falls in a large hospital in the south of Brazil: A 6-year retrospective study
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Associations between polypharmacy and physical performance measures in older adults
Özkök, S., Aydın, Ç. Ö., Sacar, D. E., Çatıkkaş, N. M., Erdoğan, T., Kılıç, C., Karan, M. A., & Bahat, G. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104553 · Cited by 28
Risk for Fractures with Centrally Acting Muscle Relaxants: An Analysis of a National Medicare Advantage Claims Database
Golden, A. G., Ma, Q., Nair, V. P., Florez, H. J., & Roos, B. A. (2010) · Annals of Pharmacotherapy · doi:10.1345/aph.1p210 · Cited by 28
The risk of fall accidents for home dwellers with dementia—A register‐ and population‐based case‐control study
Petersen, J. D., Siersma, V., Christensen, R. D., Storsveen, M. M., Nielsen, C. T., & Waldorff, F. B. (2018) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1016/j.dadm.2018.05.004 · Cited by 27
“Sedative medications and their combinations have been identified as risk factors for falls in earlier studies [42,43].”
Result
Fall-risk increasing drugs and prevalence of polypharmacy in older patients discharged from an Orthogeriatric Unit after a hip fracture
Correa-Pérez, A., Delgado‐Silveira, E., Martín‐Aragón, S., Rojo-Sanchís, A. M., & Cruz-Jentoft, A. J. (2018) · Aging Clinical and Experimental Research · doi:10.1007/s40520-018-1046-2 · Cited by 28
Initial treatment choices for long‐term remission of chronic insomnia disorder in adults: a systematic review and network meta‐analysis
Furukawa, Y., Sakata, M., Furukawa, T. A., Efthimiou, O., & Perlis, M. (2024) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13730 · Cited by 27
The Effects of a Wearable Sensory Prosthesis on Gait and Balance Function After 10 Weeks of Use in Persons With Peripheral Neuropathy and High Fall Risk – The walk2Wellness Trial
Oddsson, L., Bisson, T. A., Cohen, H. S., Jacobs, L., Khoshnoodi, M. A., Kung, D. H., Lipsitz, L. A., Manor, B. D., McCracken, P., Rumsey, Y., et al. (2020) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2020.592751 · Cited by 26
“Prior to using Walkasins, the patient had received balance therapy twice a week for over 5 months by an expert physical therapist (DW) and had plateaued in his improvements (Wrisley et al., 2018, 2020).”
BackgroundMethodResultInfluential
Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series
Wang, G. H., Man, K. K. C., Chang, W. H., Liao, T., & Lai, E. C. (2021) · BMJ · doi:10.1136/bmj.n1925 · Cited by 27
Depression, Anxiety, and Patterns of Mental Health Care Among Men With Prostate Cancer Receiving Androgen Deprivation Therapy
Tsao, P. A., Ross, R. D., Bohnert, A. S. B., Mukherjee, B., & Caram, M. E. V. (2022) · The Oncologist · doi:10.1093/oncolo/oyab033 · Cited by 31
Management of Stable Angina in the Older Adult Population
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Geriatric Conditions, Medication Use, and Risk of Adverse Drug Events in a Predominantly Male, Older Veteran Population
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Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study ‘Good Ageing in Skåne’
Stenhagen, M., Nordell, E., & Elmståhl, S. (2013) · Aging Clinical and Experimental Research · doi:10.1007/s40520-013-0015-z · Cited by 27
“A number of studies have reported relationships between falls and psychotropic and psychoactive drugs [4, 7, 8, 11, 13, 15, 17, 25, 26].”
Background
Elderly Benzodiazepine Users at Increased Risk of Activity Limitations: Influence of Chronicity, Indications, and Duration of Action—The Three-City Cohort
Carrière, I., Mura, T., Pérès, K., Norton, J. L., Jaussent, I., Edjolo, A., Rouaud, O., Berr, C., Ritchie, K. A., & Ancelin, M. (2014) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.10.006 · Cited by 27
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Background
Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort
Carrière, I., Farré, A., Norton, J. L., Wyart, M., Tzourio, C., Noïze, P., Pérès, K., Fourrier‐Réglat, A., & Ancelin, M. (2016) · Osteoporosis International · doi:10.1007/s00198-016-3667-7 · Cited by 27
“Several meta-analyses and reviews have reported an increased risk of falls in the elderly[6-9] as well as fractures[10, 11], although not consistently.”
Background
The Association between Polypharmacy and Hip Fracture in Osteoporotic Women: A Nested Case–Control Study in South Korea
Park, H., Kim, S., Sohn, H. S., & Kwon, J. (2018) · Clinical Drug Investigation · doi:10.1007/s40261-018-0716-3 · Cited by 27
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Background
Psychotropic drug-related fall incidents in nursing home residents living in the eastern part of the Netherlands
Janus, S. I. M., Reinders, G. H., van Manen, J. G., Zuidema, S. U., & IJzerman, M. J. (2017) · Drugs in R&D · doi:10.1007/s40268-017-0181-0 · Cited by 26
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Use of Potentially Inappropriate Medications in People With Dementia in Vietnam and Its Associated Factors
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“Apart from worsening cognitive impairment,(52) sedatives also increase the risk of falls.(53) People with dementia have impaired cognition and are vulnerable to falling,(54) thus should not be prescribed sedatives and anticholinergics where possible.”
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The Association of Medication-Use and Frailty-Related Factors with Gait Performance in Older Patients
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BackgroundResult
Biologic disease-modifying anti-rheumatic drugs and the risk of non-vertebral osteoporotic fractures in patients with rheumatoid arthritis aged 50 years and over
Roussy, J., Bessette, L., Bernatsky, S., Rahme, E., & Lachaîne, J. (2013) · Osteoporosis International · doi:10.1007/s00198-013-2321-x · Cited by 25
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Background

Authors: Woolcott, J. C.
Affiliations: University of British Columbia (CA)
Corresponding author: Woolcott, John C.
ORCID: Woolcott, John C.
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2009-11-01
Volume: 169
Issue: 21
Pages: 1952
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinternmed.2009.357
OpenAlex: W2094113973
Cited by: 1,326
References: 54
Citations by year: 2026: 42 · 2025: 42 · 2024: 67 · 2023: 57 · 2022: 70 · 2021: 116 · 2020: 93 · 2019: 122 · 2018: 107 · 2017: 99 · 2016: 80 · 2015: 89 · 2014: 83 · 2013: 83 · 2012: 71
FWCI: 5.97
Type: journal article
Language: en
Open access: closed
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords: falls in older adults, fall risk, antihypertensive drugs, diuretics, beta-blockers, sedative-hypnotic drugs, antidepressants, benzodiazepines, narcotics, nonsteroidal anti-inflammatory drugs, drug safety, fall prevention, geriatric pharmacology, polypharmacy
MeSH terms: Accidental Falls, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Antidepressive Agents, Bayes Theorem, Benzodiazepines, Cardiovascular Agents, Cross-Sectional Studies, Diuretics, Humans, Hypnotics and Sedatives, Narcotics, Risk Factors, Sensitivity and Specificity, Antipsychotic Agents, Odds Ratio, Case-Control Studies, Randomized Controlled Trials as Topic

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Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons

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